Wednesday, December 17, 2008

The health insurer Wellpoint is testing a new program that gives covered patients the option of going to India for elective surgery, with no out-of-pocket medical costs and free travel for both the patient and a companion.

The program is being tested at Serigraph, a printing company in Wisconsin whose managers have been looking for ways to curb rising health care costs, said Dr. Razia Hashmi, chief medical officer for national accounts for Anthem Blue Cross and Blue Shield, which is affiliated with Wellpoint.

"This is a first for us," Dr. Hashmi said. "We will be monitoring every aspect of this very closely, to make sure everyone is satisfied and there are good clinical outcomes."

By the year 2010, more than 6 million Americans annually will be seeking medical treatment abroad , according to the Deloitte Center for Health Solutions, a consultancy. The potential savings are significant. Knee surgery that costs $70,000 to $80,000 in the United States can be performed in India for $8,000 to $10,000, including follow-up care and rehabilitation, Dr. Hashmi said. Similar savings could be achieved for such common procedures as hip replacements and spine surgery .

If other insurers follow Wellpoint, Dr. Hashmi said, the trend ultimately may pressure on United States hospitals to be more competitive in their pricing.

Critics say that's unlikely.

"There have been some reports of hospitals that have been willing to match the prices, but I don't know how they're doing that," said Howard Berliner, a professor of health policy and management at State University of New York Downstate Medical Center in Brooklyn. "The reality is there's just no way that most hospitals can respond to this. It's just like any service that's outsourced - the price is so cheap abroad that there isn't much an American company can do about it."

At the same time, he said, the program could potentially siphon off the healthiest, most profitable patients from a local hospital.

Dr. Hashmi predicted that the program would appeal primarily to people who have traveled abroad. Many employees of Serigraph, which has offices in India, are familiar with the country.

"The quality is comparable" to care provided in the United States, Dr. Hashmi said. All the physicians speak English, and patients can share their medical records and consult with a surgeon in India before making the trip, she said.

The pilot program arranges for patients to be picked up at the airport and provides special meals to prevent food-borne illnesses. The program complies with the American Medical Association guidelines on medical tourism and uses hospitals accredited by the Joint Commission International.

Dr. Hashmi said it had actually been easier to evaluate the quality of medical care abroad than in the United States. "There is a lot more willingness to share data about complication rates, the total number of procedures and the outcomes," Dr. Hashmi said. "We're able to get detail per hospital and per physician."

In addition to saving out-of-pocket costs for surgery for patients, the program could potentially help keep insurance premiums affordable, Dr. Hashmi said.